A. It is always a good idea to find the cause of heavy bleeding. It can be caused by abnormal hormones, by a polyp or fibroid, by an infection or sometimes by a cancer. There are many more reasons as well. It should be possible to find out the cause. Before you have a hysterectomy it is always a good reason to try and find the cause of the problem. This could be done first step by and ultrasound or doing a biopsy (taking a few cells from the lining in the office for looking at under the microscope). A hysteroscopy is also often done, which is looking into the uterine lining with a telescope or doing a D&C which scrapes out a larger amount of tissue to make a diagnosis and sometimes stops the bleeding as well. These are usually done in the operating room with anesthesia and the person goes home the same day. Repeating the ultrasound at this point does seem reasonable to understand what is there. Things will have changed after the ablation but the cause of the problem seems to still be there. Maybe you had a polyp and some of it was removed but not all. That can happen. When these things are done, it should be possible to understand the causes and then you can decide if you still want a hysterectomy. Since hysterectomy can result in blood loss, it is a good idea to begin taking iron and a multivitamin to try and build up you blood count. That might help stop the bleeding and is good planning before surgery.
Machelle M. Seibel, MD